A Brief Overview of Hospitalized COVID-19 Patients from an Inner-City, Residents-Run Clinic

Abstract

Rationale: Background: On December 29, 2019, the first 4 cases of the novel coronavirus (COVID-19) were identified in Wuhan, China. The northeastern United Sates experienced the first wave between March 1 and June 30, 2020. Poor, inner-city patients experienced the highest hospitalization and mortality rates. Many were elderly and had underlying medical conditions, including chronic kidney disease, morbid obesity and diabetes. The full impact of COVID-19 on the inner city patients has not been fully studied. The goal of this study is to describe the clinical characteristics and outcomes of patients from an inner-city residents run clinic hospitalized with COVID- 19 during the first wave of COVID-19 pandemic in Northeastern USA from March 1 through June 30, 2020. Methods: We identified hospitalized patients with COVID-19 from an inner-city, residents run primary care clinic by reviewing daily COVID-19 admissions and matching the list with the clinic database of the patients. Identified patients were prospectively followed during and after their hospital stay. Data abstracted included demographic characteristics, co-morbid conditions, intubations, durations of ICU and hospital stay and in-hospital mortality. Results: A total of 40 patients from the Bridgeport Hospital Primary Care Center were admitted to Bridgeport Hospital, Yale New Haven Health, between March 1 and June 30, 2020. They were 26 men and 14 women, between 21 and 88 years (Median 54 years). Most (60%) were Hispanics. About 32.5% were African-Americans and 7.5% were Caucasians. About 32.5% (13 out of 40) were aged 60 years or over. The predominant comorbid conditions were hypertension (45%), diabetes mellitus (35%), ischemic heart disease (22.5%), chronic kidney disease (11.6%), and lung diseases (9.3%). 25% (10/40) had BMI of 35 or over. About 31% (12 out of 40) were intubated for acute hypoxemic respiratory failure. The median duration of hospital stay was 9 days (range from 1 to 47 days). The in-hospital mortality rate was 22.5%. Age 60 years or older was the single best predictor for in-hospital mortality after adjusting for BMI and other co-morbid conditions (adjusted OR 35.6, 95% CI: 2.1, 605.7, p=0.01). Conclusion: The in-hospital mortality rate for the hospitalized inner-city clinic patients was 22.5%. Many of the patients had significant co-morbid conditions. Age 60 or more was the best predictor of mortality. The very high mortality rate among hospitalized inner city patients mandates that aggressive preventive strategies are implemented to slow the spread of COVID-19 in this patient population group.